Post-CEA seizure was associated with adverse outcome. Most were labile hypertensives with severe bilateral carotid/vertebral disease. MCAV changes suggested poor collateral recruitment, but no consistent pattern of early hyperperfusion emerged. It remains uncertain whether high MCAVs and severe hypertension after seizure onset are cause or effect. Clinicians treating these patients in acute medical units were generally unaware of the "post-CEA hyperperfusion syndrome" and tended to treat the hypertension less aggressively.

The group most involved in temperature measurement was characterized as nursing auxiliary grades with the fewest years of experience. IRTT was the most frequently-used method for measuring patient temperatures, with high perceived accuracy, reliability, ease of use and acceptability to patients. A poor level of understanding and training in the use of IRTT was revealed across all clinical grades. Recommendations for future investigations are made.

Blood lead, ethnic origin, and lead exposure 975 exposure on child behaviour or intelligence could not be ruled out by the present study, but these effects, if real, are tiny compared with other factors which influence childrens' physical and mental development.6We express our appreciation to the families of Walsall and their general practitioners, who allowed us to study the children, and to the health visitors based at Walsall Manor Hospital who carried out the field work for the survey. We also thank staff of the department of clinical chemistry, Walsall Manor Hospital and the departmcnt of haematology, Dudley Road Hospital, Birmingham for carrying out additional investigations. ReferencesArcher

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